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Contractor Registration Form
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West Melbourne | Building Division
2240 Minton Road | West Melbourne, FL 32904
Tel: 321.837.7776 | Fax: 321.952.9542
www.westmelbourne.org
Contractor Registration Form
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*
New Registration
Update Information
Name of Qualifier
*
Company Name
*
Business Address
*
City
State
Zip
Phone
*
Fax
Email
For proper registration, you shall provide all updated information that apply to your contractor's qualifications. Incomplete and missing information will delay the registration process, and as a result no applications for permit will be properly processed.
* Certified Contractor (State License).
Trade
* Brevard County Contractor (Certificate of Competency).
Trade
* Liability Insurance (City of West Melbourne as certificate holder).
* Workman's Compensation (City of West Melbourne as certificate holder) or Florida's exemption.
* Business Tax Receipt (Former Occupational License).
Name of Authorized Person to submit and pickup permit applications:
Phone
Email
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